COVER-PRO
SM
APPLICATION
TUTOR SUPPLEMENT
1. Full name of the Applicant Firm:
2. What certifications does the Applicant hold?
3. What degrees does the Applicant hold?
4. Does the Applicant provide services to home-schooled s
tudents?
Yes No
5. Is a tutorial plan utilized for each client?
Yes No
6. Where are services provid
ed?(e.g. at client location, library, or the
applicant’s residence)
7. What type and subject mat
ter of tutoring is provided?
ADDITIONAL INFORMATION
This section may be used to provide additional information to
any question on this application. Please
identif
y the question number to which you are referring.
I understand that the information submitted herein becomes a part of my Philadelphia Insurance
Companie
s Cover-Pro
sm
application and is subject to the same conditions as stated on the application.
Name (Please Print) Title (Must be Principal, Partner or Officer
)
__________________________________________
Signature Date
PI-PLSP-TUSUPP 08/10
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